This was not an event focused on open source but I spent the day there because I believe that primary care generated patient data is at the center of the patient data universe. It is also where there is the least penetration of commercial information technology systems in the United States. There are several open source projects now working to fill this gap and we will hear more about them later this week.
While originally hailed as a combined EFMI, IMIA, AMIA Primary Care Informatics Working Group Consensus Conference This day-long mini-conference was very US centric though there were several representatives from other countries in attendance.

The representatives from other countries in attendance did add a great deal to assist in answering the question of the day; “What is Primary Care”?
There was certainly consensus in the answer I heard which was; that it is first, foremost, fundamental and varied. This is pretty vague stuff and really only served to repeat what has been stated many times before.

The day started with the PCIWG Chair-elect, Sheliea Teasdale introducing Dr. Alan Zuckerman for an introduction to the National Alliance for Primary Care Informatics (NAPCI). NAPCI is a relatively new organization as a formal organization. The need was identified several years ago by members of the AMIA PCIWG. You can read more about “NAPCI at their website”:http://www.napci.org In short, they want to be the overall primary care informatics representative organization. Dr. Zuckerman also spoke about several of the events that have occurred concerning medical informatics this year. In particular he made mention of the “NHII conference and reports”:http://aspe.hhs.gov/sp/nhii/ , a “Physician’s EHR Coalition”:http://www.aafp.org/x28539.xml that now includes a total of 19 professional societies, the “ASTM CCR initiative”:http://www.aafp.org/x24962.xml and of course the; “AAFP open source EHR that was never really intended to be truly open source”. No, I do not understand the meaning of that phrase either but there is no point in following that up. I think we all understand now that it was simply a misunderstanding of the terms. I had a short chat with Dr. Bates regrading the definition of open source and received a cordial acknowledgment to this effect.

Dr. Zuckerman believes that the primary care informatics community should concentrate on vocabulary implementations such as using the UMLS embedded version of SNOMED/CT. He feels that this is doable by the vendors if the users will only demand it from them. In his view this will provide some accomplishment by primary care in affecting the way systems work for them.
The attendees were then broke out into four groups in an effort to define primary care. See my above comments on this effort.

After a review of the definition of Primary Care four groups were broken out with the following tasks; Group 1 – Define Informatics, Group 2a & Group 2b – Define the role of Informatics in Primary Care Practice, Group 3 – Define the relationship between primary care informatics and public health.

After the lunch break, Dr. David Bates gave a whirlwind tour of the world of primary care informatics keynote address. Several of his slides seemed to project differing figures for various penetration rates of IT in healthcare in the UK and Australia. I asked for a copy of the slides so I could look them over before writing this but was told that they’ll be on the website soon. At this point I’m not certain if it was the jet-lag (Dr. Bates is just returning from a 3 month sabbatical), my misunderstanding of what was depicted or simply that he had conflicting data generated over the past four years. Either way, the bottom line is that massive penetration of IT software/hardware is easier to attain in countries with a government funding mandate for health care. An important statistic noted by Dr. Bates from the “Center for IT Leadership”:http://www.citl.org/about/executiveCommitteeStaff.htm that says that 89% of the benefits of primary care IT system implementation goes to stakeholders other than the primary care provider. This obviously begs the question of how to create the paradigm shift so that those deriving the benefits are the ones paying for the implementation and use. The answer to this question is certainly outside the scope of the AMIA PCIWG.

Dr. Bates mentioned two time-motion studies one by him and his group (??) and one by “Dr. Marc Overhage at Regenstrief”:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=130081&rendertype=abstract validating that after gaining familiarity with an IT system physicians can actually improve patient care and not take much if any longer during the consultation.

The closing session was a panel of Dr. John Zapp, Dr. David Bates and Dr. Alan Zuckerman. Their task was to review the earlier breakout group results and comment.

Dr. Zapp said; “The ideas and energy should capitalized on by not walking away from this meeting without a plan.”

Dr. Bates said; “We need to educate the providers on how to use information systems.”

Dr. Zuckerman said; “… we must understand the time value of information to avoid future information overload.”

Look for more daily reviews from MedInfo2004. The open source events are just beginning.